快速康复外科联合微创手术在老年大肠癌患者中的短期效果分析

Short-term impact of fast track surgery combined with minimally invasive surgery on elderly patients with colorectal cancer

目的探讨快速康复外科(FTS)联合腹腔镜下大肠癌根治术在老年大肠癌患者中的应用效果。方法选取2013年7月-2015年7月于该院胃肠外科采用腹腔镜手术治疗的200例老年大肠癌患者为研究对象,将患者随机分为加速康复组及对照组,每组100例患者,研究组患者围手术期给予快速康复方案治疗,对照组给予常规治疗。比较两组患者术中情况、术后恢复情况及术后并发症发生率,调查两组患者术后2周的生活质量水平。结果快速康复组患者在术中出血量、手术时间及淋巴结清扫个数方面与对照组差异无统计学意义(P>0.05)。加速康复组患者术后肛门排气时间、下地活动时间、开始进食时间、输液时间及住院时间明显短于对照组,差异均有统计学意义(P<0.05),其总住院费用明显低于对照组(P<0.05)。加速康复组术后咽痛、腹胀、肺部感染的发生率及并发症总发病率均明显低于对照组,差异均有统计学意义(P<0.05)。加速康复组患者治疗满意为率96.0%(96/100)明显高于对照组82.0%(82/100),差异有统计学意义(P<0.05)。欧洲癌症研究与治疗组织(EORTC)的生存质量核心问卷(QLQ-C30)调查结果显示加速康复组患者总体健康、情绪功能及社会功能评分明显高于对照组(P<0.05),而恶心呕吐、疼痛、失眠、食欲减退和便秘评分明显低于对照组(P<0.05)。结论快速康复治疗联合腹腔镜在老年大肠癌的治疗中安全有效,可以促进老年患者的术后康复,提高患者的治疗满意度及近期生活质量。

Objective To analyze the short-term impact of fast track surgery（FTS） combined with minimally invasive surgery on elderly patients with colorectal cancer. Methods 200 patients with colorectal cancer received laparoscopic surgery from July 2013 to July 2015 were selected and randomly divided into control group and FTS group.Patients in control group received conventional perioperative treatment and patients in FTS group received perioperative management according to fast track surgery. Status of intraoperative, postoperative recovery and the postoperative complication rate were compared between the two groups. Patients＇ quality of life were analyzed after two weeks of operation. Results Compared with the control group, the blood loss, operation time and number of lymph node dissection of patients in FTS group showed no significant difference（P〉0.05）. Flatus time, ambulation time, start eating time, the infusion time and length of hospital stay in FTS group was significantly shorter than the control group, the difference was statistically significant（P〈0.05）. The total cost of hospitalization of FTS group was significantly lower than the control group（P〈0.05）. The incidence of sore throat, abdominal distension, lung infections and overall complications incidence rate in FTS group were significantly lower than the control group, the difference was statistically significant（P〈0.05）. The satisfaction rate in FTS group was 96.0 %（96/100）, and was significantly higher than the control group 82.0 %（82/100）, the difference was statistically significant（P〈0.05）. QLQ-C30 results showed that scores of overall health, emotional function and social function of FTS group were significantly higher than the control group（P〈0.05）, and scores of nausea and vomiting, pain, insomnia, anorexia, constipation were significantly lower than the control group（P〈0.05）. Conclusion Laparoscopy combined with FTS is safe and effective in treatment of colorectal cancer in the elderly patients, which can promote postoperative rehabilitation, improve patient satisfaction and quality of life in short term.